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Background Recent studies conducted in several OECD countries have shown that chronic exposure to elevated levels of air pollutants (especially PM 2.5 , PM 10 and NOx), might negatively impact COVID-19 morbidity and mortality rates. The aim of this study was to examine the association between chronic exposure to air pollution in Israeli cities and towns, their demographic and socioeconomic status, and COVID-19 morbidity, during the three local morbidity waves. Methods We examined the associations between: (a) annual average concentrations of NOx, CO, PM 10 , PM 2.5 and SO 2 in 2016–2019, and demographic and socioeconomic parameters, and (b) COVID-19 positive cases in 279 Israeli cities and towns, in the four state-wide morbidity peaks: 1 st wave peak: March 31 st , 2020; 2 nd wave peaks: July 24 th and September 27 th , 2020, and the 3 rd wave peak: January 17 th , 2021, which occurred after the beginning of the nationwide vaccination campaign. These associations were calculated using both Spearman correlations and multivariate linear regressions. Results We found statistically significant positive correlations between the concentrations of most pollutants in 2016–19 and COVID-19 morbidity rate at the first three timepoints but not the 4t h (January 17 th , 2021). Population density and city/town total population were also positively associated with the COVID-19 morbidity rates at these three timepoints, but not the 4 th , in which socioeconomic parameters were more dominant - we found a statistically significant negative correlation between socioeconomic cluster and COVID-19 morbidity. In addition, all multivariate models including PM 2.5 concentrations were statistically significant, and PM 2.5 concentrations were positively associated with the COVID-19 morbidity rates in all models. Conclusions We found a nationwide association between population chronic exposure to five main air pollutants in Israeli cities and towns, and COVID-19 morbidity rates during two of the three morbidity waves experienced in Israel. The widespread morbidity that was related to socioeconomic factors during the 3 rd wave, emphasizes the need for special attention to morbidity prevention in socioeconomically vulnerable populations and especially in large household communities. Nevertheless, this ecological study has several limitations, such as the inability to draw conclusions about causality or mechanisms of action. The growing body of evidence, regarding...

Studies conducted in the early COVID-19 pandemic stages showed positive associations between chronic exposure to ambient air pollution and COVID-19 morbidity. Here, we examined the associations between populations’ chronic exposure to air pollutants (NO2, CO, PM10, PM2.5, and SO2), demographics, and vaccination rates, to COVID-19 morbidity rates in 280 Israeli municipalities during the Delta-variant-dominated morbidity wave of summer 2021. We found that COVID-19 morbidity was positively associated with chronic exposure to air pollutants, the municipality’s population density, total population size, and the rate of elderly people. Multivariate linear regression models showed similar trends: positive associations between COVID-19 rates and density, ratio of elderly people, and most air pollutants, and a non-significant link to COVID-19 vaccine second dose ratio. Our results emphasized the effects of chronic air pollution exposure on the spread of the pandemic and strengthen the urgent need for uncompromising policy for a dramatic reduction in air pollution. They also highlighted the vulnerable populations (elderly, densely populated municipalities) during the Delta morbidity wave. These findings could assist policy makers to better inform the public and manage health policies in future COVID-19 waves, hopefully leading to a reduced impact on health.

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